What Is the HCFA 1500 Claim Form?

The HCFA 1500 claim form, also known as CMS-1500, enables medical facilities to submit health insurance claims to insurance carriers such as Medicare and Medicaid; this form can be sent electronically. This form requires a lot of personal patient and insurance policy information. The form is available for download online.

When filling out the CMS-1500 form, include patient data such as name, address, marital status, work status and date of birth. If the patient is on somebody else’s insurance plan, the other insured party’s information should be included. Other information on the form includes the patient’s condition, hospitalization dates, diagnosis, related procedures and referrer if applicable.